My worst nightmare. IBS, Kidney, appetite.

[JC fka JClark]

Old poster, new name.

This is both a rant and seeking advice. So a little back story. Early on we tried some chicken flavors of cat food but Cat B threw them up otherwise it was always a combination of some novel protein (Lamb, Venison, Salmon, Pork, Rabbit) in both wet/dry.

Cat A (7 yrs old, Male): Noticed he felt a little skinny. Brought to vet and he had lost a little less than 2 lbs (17 to 15). Teeth were okay and Vet ran a kidney panel.Everything came back normal except for 3 markers which in totality suggest early kidney issue. One was white blood cell count (slightly low) but said that could be stress from the visit., Another was Creatinine which was slightly elevated but could be related to slight dehydration. Recommendation was to increase intake of wet food transition to a "Senior diet" and re-evaluate in a couple of months.

We noticed that he wasn't eating his dry food (Instinct Rabbit) and thought that it was because the food bin had allowed it to go rancid. This dry food is also high in phosphorous. In addition he really wasn't eating much of his wet (Instinct Venison). He's a nibbler rather than a eater like his brother. So in a panic I embarked on a quest to find lower phosphorous dry and wet. Tried a few samples of dry which he ate but rejected once we bought a bag. I think we've found some wet (Dave's Low Phosphorus Chicken and Fussie Cat Chicken/Herring) which we can rotate in with Venison wet. He did like Instinct Salmon but that led to an issue with Cat B (see below). We can still only entice him to "eat" the wet with crushed treats and he's 1/3 of the way through a course of Mirtazapine. He will not touch any dry but we haven't yet tried to re-visit instinct Rabbit via fresh bag.

Cat B (7 yr old, Male): Had a stomach issue last March/April. I had been feeding the cats a rotation of wet/dry foods and all of a sudden this guy developed an issue. We got it sorted out by moving to two proteins (Venison wet, Rabbit dry). Fast forward to August and while we were trying to get Cat A to start eating I forgot about the issue we had with Cat B a few months prior. Long story short it appears the Cat B is allergic to Salmon. It really did a number on his digestive system. He just finished a course of metronidazole and is halfway through a box of FortiFlora.

Questions.

Cat A: Any suggestions on how to convert a nibbler into an eater? I've transitioned from panic, to sadness, to annoyance with sadness. I now feed my cats 5 times a day and I need this guy to eat all of his portion at every feeding because it either goes to waste (wet), gets eaten by brother, or I pick it up and re-heat an hour or two later adding more crushed treats. Reheating is exhausting because it takes 4-5 feeding to get him to down a 5 oz can of wet. One day he's a chewer (Will eat pieces of steak) and the other day he's a gravy only.

Cat B: Since he's finished his course of metronidazole I'm nervous that he'll relapse because I've added chicken to their diets for Cat A. Since Cat A is a nibbler I really can't feed them separately and I can't wall off half the house

All suggestions welcome on how to tackle this situation. The last thing I want to do is go through the agony of having to decide which cat I want to put up for adoption.

 

[Freshpuppet3489]

Not sure how helpful this will be, I had a dog with kidney failure. The vet said that it was caused by the food. To high protein for her to handle. It was good quality food, earthborn holistics. Ig some animals can’t handle certain proteins, the vet said pea protein is not good as it can disrupt the absorption of other proteins. I would also make sure they drink a lot, they made us give her an iv 1 time a day so she could have fluids to clear her kidneys. I hope that helps a little at least. It’s difficult to lose a pet to kidney failure I hope they do better

 

[mrsgreenjeens]

Well, having had three kidney cats, and knowing just how difficulit it is to get them to eat period, I feel your pain You mentioned THREE markers for kidney disease, but only mentioned two. What was the third? Did they check SDMA? That is usually the best marker for early kidney disease, even before creatinine goes above normal. But could something else be going on rather than kidney disease? With low WBC there could be something else happening I suppose. Especially since the mirtazapine isn't working, because in EARLY stages of kidney disease, appetite shouldn't be too affected. But it's possible the mirt simply isn't effective for Cat A and you might should ask the Vet if you could try another appetite stimulant. Also, here is a great website for all things kidney cat, and they have listings of food in order of the amount of phosphorus in it, both for wet and dry. I would suggest picking up a variety of cans and just have them around. Switch it up meal to meal and see what really entices him. I always tried to keep the phosphorus under 1%, but our Vet said the most important thing was to keep them eating, so sometimes the phos would be really high, and sometimes low, so we just didn't worry about it. Our Vet figured it all evened out in the long run. Here's that website: http://www.felinecrf.org/canned_food_usa.htm#canned_usa

I have two cats that eat totally different diets, so it IS possible to feed cats separately. I just feed the one who eats regularly scheduled meals in the kitchen, and I feed the other one wherever I happen be. That way i can keep an eye on his bowl to make sure his brother doesn't come in and eat out of it while my "grazer" decides if he's going to eat or not. It's not ideal, but it's what we've got.

In the meantime, here are a couple of articles on how to get cats "in line" when it comes to food: (I need to re-read these again myself ) I included the 2nd article because it really would be best if you could get Cat A on an ALL WET diet.

Transitioning Free-fed Kibble Kitties To Timed Meals – TheCatSite Articles

Transitioning Your Cat From Kibble To A New Type Of Food – TheCatSite Articles

 

[JC fka JClark]

Well, having had three kidney cats, and knowing just how difficulit it is to get them to eat period, I feel your pain You mentioned THREE markers for kidney disease, but only mentioned two. What was the third? Did they check SDMA? That is usually the best marker for early kidney disease, even before creatinine goes above normal. But could something else be going on rather than kidney disease? With low WBC there could be something else happening I suppose. Especially since the mirtazapine isn't working, because in EARLY stages of kidney disease, appetite shouldn't be too affected. But it's possible the mirt simply isn't effective for Cat A and you might should ask the Vet if you could try another appetite stimulant. Also, here is a great website for all things kidney cat, and they have listings of food in order of the amount of phosphorus in it, both for wet and dry. I would suggest picking up a variety of cans and just have them around. Switch it up meal to meal and see what really entices him. I always tried to keep the phosphorus under 1%, but our Vet said the most important thing was to keep them eating, so sometimes the phos would be really high, and sometimes low, so we just didn't worry about it. Our Vet figured it all evened out in the long run. Here's that website: http://www.felinecrf.org/canned_food_usa.htm#canned_usa

I have two cats that eat totally different diets, so it IS possible to feed cats separately. I just feed the one who eats regularly scheduled meals in the kitchen, and I feed the other one wherever I happen be. That way i can keep an eye on his bowl to make sure his brother doesn't come in and eat out of it while my "grazer" decides if he's going to eat or not. It's not ideal, but it's what we've got.

In the meantime, here are a couple of articles on how to get cats "in line" when it comes to food: (I need to re-read these again myself ) I included the 2nd article because it really would be best if you could get Cat A on an ALL WET diet.

Transitioning Free-fed Kibble Kitties To Timed Meals – TheCatSite Articles

Transitioning Your Cat From Kibble To A New Type Of Food – TheCatSite Articles

Unfortunately I don't remember the third marker. Our Vet explained it as that the results overall didn't indicate kidney issues but pointed out three markers which were slightly out of bounds but not enough to offer a definitive diagnosis. I'm also familiar with felinecrf.org as I used it to try to find foods lower on phosphorous and were compatible with both cats. I'll check out the links you provided on feeding both cats.

So being the typical obsessive cat owners we picked up some Nature's Variety Limited Ingredient (Rabbit) Dry. Based upon the ingredient list it seemed to be a good in-between for both my cats and both have done well on Rabbit. The jury is out on how they'll both respond but I can't describe the amount of relief we experienced when was got home. The Cat A (weight loss primary issue) went absolutely nuts when he heard the bag in my hand as I walked into the house. Gave him a 1/3 cup and he devoured it. This morning ate a lot as well (Mixed in with wet).

So the current diet is going to be a combination of wet/dry and time will tell how they respond. These guys are only 7 yrs old so I want to try to provide them with at least a litte more protein than they would normally get on the urinary/IBS gruel.

Wet:
Dave's Pet Food Restricted Diet Protein-Phosphorus Chicken Lickin' Good (.39 Phos DMA) (Dave's also has a Pork which is low in Phos and Mg)
AND
Instinct Original Grain-Free 95% Real Venison Pâté (1.92 Phos DMA)

Dry:
Instinct Limited Ingredient Diet Rabbit (1.10 Phos DMA)

 

[mrsgreenjeens]

So glad he's eating like a champ now! Good job finding something he likes.

 

[moxiewild]

Phosphorus -

Unless that third elevated marker was phosphorus, you shouldn’t be feeding him food too low in phosphorus - especially since you don’t even know if it’s actually CKD yet.

You certainly should not be feeding a food with phosphorus lower than AAFCO requirements when 1. Phosphorus is not elevated, and 2. You don’t even have a definitive CKD diagnosis yet.

You are getting way ahead of yourself here, it is way too soon for this. Take a breath and ground yourself in the present.

I know a potential diagnosis like this can be so overwhelming, but you’re treating a cat without a CKD diagnosis as if he has Stage 3 CKD. It’s unnecessary, and potentially harmful.

I don’t mean to sound harsh, because it is more than evident that you are only doing this because you are an incredibly caring and responsible pet parent. You just seem to be going into overdrive right now based on what you’ve said here.

And I’m quite familiar with the sort of panic and obsession that can lead to a place like this, so trust me when I say that I’m not attacking you and all of this is coming from the heart!

Instead of focusing so much on phosphorus, I would be focusing on calories of any given food. Particularly calories from (animal) protein and fat to help him regain/build muscle mass.

If you’re to do anything regarding phosphorus, then chuck the Dave’s and Instinct Venison and find something in between those two (easier said than done, I know!).

One is way too low in phosphorus, and the other is very high. Better to go moderate than switch back and forth hoping the two will balance things out, which is potentially taxing on the kidneys.

Ask your vet to email his labs to you. From here on out, always keep a copy of everything.

Medications -

Was Mirtazapine all that was prescribed? Appetite stimulants can help, but it will only do so much if nausea (and/or stomach acid) aren’t also addressed.

Feeding Difficulties -

If you have the budget, consider a microchip feeder. This will keep their food separate, and also keep food fresh a little longer. SureFeed is a good one.

Before we could afford SureFeed though, we actually purchased their microchip cat door (~$30), and installed it in a large, clear Rubbermaid bin. So only the approved kitty could get into the bin to access food.

Alternatively, you can purchase an automatic wet food feeder that will feed him small portions of wet and/or dry periodically so that you aren’t constantly having to feed. It will keep the food cool and covered.

Pop an auto feeder into a storage tote with a microchip door installed, and your issues might be covered!

I know the sort of exhaustion you’re talking about with having to do frequent feedings, use crushed treats, and wasted food.

And I reeeally hate to say it, but if he does have CKD, this is very often life with a kidney cat :/ Not always, but it’s very common.

For what it’s worth, you grow used to it over time, especially once you’ve settled into your tricks and routine. It’s always annoying, but that annoyance is dulled over time as you settle into things.

You’re going to have to learn to accept wasted food though. It’s part of the costs incurred with a kidney cat.

Instinct LID Rabbit -

Monitor the litter box closely with this one! I swear every single cat we’ve fed that to ends up with diarrhea - including the cat who ONLY tolerates rabbit!

 

[JC fka JClark]

Phosphorus -

Unless that third elevated marker was phosphorus, you shouldn’t be feeding him food too low in phosphorus - especially since you don’t even know if it’s actually CKD yet.

You certainly should not be feeding a food with phosphorus lower than AAFCO requirements when 1. Phosphorus is not elevated, and 2. You don’t even have a definitive CKD diagnosis yet.

You are getting way ahead of yourself here, it is way too soon for this. Take a breath and ground yourself in the present.

I know a potential diagnosis like this can be so overwhelming, but you’re treating a cat without a CKD diagnosis as if he has Stage 3 CKD. It’s unnecessary, and potentially harmful.

I don’t mean to sound harsh, because it is more than evident that you are only doing this because you are an incredibly caring and responsible pet parent. You just seem to be going into overdrive right now based on what you’ve said here.

And I’m quite familiar with the sort of panic and obsession that can lead to a place like this, so trust me when I say that I’m not attacking you and all of this is coming from the heart!

Instead of focusing so much on phosphorus, I would be focusing on calories of any given food. Particularly calories from (animal) protein and fat to help him regain/build muscle mass.

If you’re to do anything regarding phosphorus, then chuck the Dave’s and Instinct Venison and find something in between those two (easier said than done, I know!).

One is way too low in phosphorus, and the other is very high. Better to go moderate than switch back and forth hoping the two will balance things out, which is potentially taxing on the kidneys.

Ask your vet to email his labs to you. From here on out, always keep a copy of everything.

Medications -

Was Mirtazapine all that was prescribed? Appetite stimulants can help, but it will only do so much if nausea (and/or stomach acid) aren’t also addressed.

Feeding Difficulties -

If you have the budget, consider a microchip feeder. This will keep their food separate, and also keep food fresh a little longer. SureFeed is a good one.

Before we could afford SureFeed though, we actually purchased their microchip cat door (~$30), and installed it in a large, clear Rubbermaid bin. So only the approved kitty could get into the bin to access food.

Alternatively, you can purchase an automatic wet food feeder that will feed him small portions of wet and/or dry periodically so that you aren’t constantly having to feed. It will keep the food cool and covered.

Pop an auto feeder into a storage tote with a microchip door installed, and your issues might be covered!

I know the sort of exhaustion you’re talking about with having to do frequent feedings, use crushed treats, and wasted food.

And I reeeally hate to say it, but if he does have CKD, this is very often life with a kidney cat :/ Not always, but it’s very common.

For what it’s worth, you grow used to it over time, especially once you’ve settled into your tricks and routine. It’s always annoying, but that annoyance is dulled over time as you settle into things.

You’re going to have to learn to accept wasted food though. It’s part of the costs incurred with a kidney cat.

Instinct LID Rabbit -

Monitor the litter box closely with this one! I swear every single cat we’ve fed that to ends up with diarrhea - including the cat who ONLY tolerates rabbit!

When feeding we mix. Dry+wet. I was also intending on mixing the wet together under the premise that phosphorus levels would average out. However, I noticed that our IBS cat has developed some scabs on his head. It makes me think he's allergic to chicken/fowel based on prior experience with another cat.

I'm familiar with the issues of the LID dry. Tried it years ago because we had a third IBD cat and they didn't do well however first bowel from both cats were fine so far.

 

[JC fka JClark]

UPDATE: LID is a no go. Cat B (IBS) started defecating around the house. I guess it's the tapioca or pea flour. So we moved to old dry which CAT A had rejected a few weeks ago. He didn't reject it this afternoon so we'll see.

Finding a novel protein is going to be impossible because their diet has always consisted of two or more of the following (Rabbit, Rabbit meal, Lamb, Chicken Meal, Salmon Meal, Venison, Pork, Tapioca).

Trip to the Vet this week. More testing for Cat B.

 

[mrsgreenjeens]

While you're at the Vet, you might want to ask about the ramifications of feeding the IBD cat low phosphorus foods, since he doesn't have kidney disease. Phosphorus is needed by "normal" cats. And as moxiewild stated up in post #6, since you don't even have a firm diagnosis of kidney disease for cat A, is it really necessary to reduce Cat A's phosphorus either? If not, then I might suggest perhaps looking into some of the freeze dried raw rabbit. It's great for IBD cats. Preferred, actually, over kibble. I know Stella and Chewy has one that ranks pretty high. Not sure who else because both my cats hate rabbit

 

[JC fka JClark]

While you're at the Vet, you might want to ask about the ramifications of feeding the IBD cat low phosphorus foods, since he doesn't have kidney disease. Phosphorus is needed by "normal" cats. And as moxiewild stated up in post #6, since you don't even have a firm diagnosis of kidney disease for cat A, is it really necessary to reduce Cat A's phosphorus either? If not, then I might suggest perhaps looking into some of the freeze dried raw rabbit. It's great for IBD cats. Preferred, actually, over kibble. I know Stella and Chewy has one that ranks pretty high. Not sure who else because both my cats hate rabbit

Keep in mind I wasn't feeding my cats a low phosphorous diet. I was tryo to reduce their phosphorous by rotating low phosphorous ( 0.39) wet food mixed in with their routine higher (2.30) phosphorous dry food in order to keep stomach issues to a minimum. As kittens we could never get them to eat wet food only so we had to mix in dry-kibble. Think of it as looking like chocolate chip cookie dough.

In any case our Vet has prescribed Hill's Prescription Diet Gastrointestinal Biome (Dry and Wet) which we can feed to both cats for 4-6 weeks. CAT B is halfway through a course of prednislone and another round of metronidazole. CAT A still on his happy pills (1x3 days Mirtazapine).

Our Vet had told us that it takes 4-6 weeks for the cells within the intestines to slough off and hopefully this diet will help re-set his system after which we can re-introduce or try a novel protein (Chicken in their case). If we're unable to transition him off onto something else or he re-lapses once he has finished with his medication then both cats will move onto a hydrolyzed protein for the rest of their lives (7 yrs old now).

Now I only have to find out why Cat B had some weird intestinal discharge which was relatively clear and non-odorous. I suspect it's the prescription food. *shrug*

 

[mrsgreenjeens]

How are they liking the new food? Hoping this all works out for everyone, cats and humans alike . What are your cats actual names, BTW? We normally work with names versus Cat A and Cat B, but this approach works as well.

 

[JC fka JClark]

How are they liking the new food? Hoping this all works out for everyone, cats and humans alike . What are your cats actual names, BTW? We normally work with names versus Cat A and Cat B, but this approach works as well.

Mixed results with the new food. They've only been fed grain-free cat food so this prescription diet is an adjustment. Of course stools have become looser for the one NOT on medication. The other cat, (sigh), what can I say other than our bed and new furniture have informed us that a loss of bladder control is a side effect of prednisolone. All I can say that it's going to be a long 4-6 weeks. Adoption anyone?

 

[mrsgreenjeens]

increased thirst, therefore increased urination is definitely a side effect of the steroid, BUT, loss of bladder control is NOT a side effect that i've ever heard of, nor can I find anything in writing on that. Have you discussed that with your Vet? That sounds more like a UTI orsome sort of bladder issue than a side effect of medication. Litterbox avoidance is usually a result of pain when going, and you already mentioned one cat was pooping all over the house, is it the same cat now peeing on the furniture? I think it's back to the Vet for a check-up

 

[JC fka JClark]

increased thirst, therefore increased urination is definitely a side effect of the steroid, BUT, loss of bladder control is NOT a side effect that i've ever heard of, nor can I find anything in writing on that. Have you discussed that with your Vet? That sounds more like a UTI orsome sort of bladder issue than a side effect of medication. Litterbox avoidance is usually a result of pain when going, and you already mentioned one cat was pooping all over the house, is it the same cat now peeing on the furniture? I think it's back to the Vet for a check-up

Here's it's listed as a LT side effect (Side Effects Of Injectable and Oral Steroids In Cats | Trudell Animal Health). In any case my vet said to bring him in if there's vomiting or diarrhea. He's urinating in the litter box. The two times he urinated outside the box he was laying down. I guess UTI is a possibility but imo it's extremely coincidental that we started to deal with this 2.5 days into his regime with Pred and metronidazole (Antibiotic). The metronidazole would treat the UTI no? And yes, it's the same cat that for the first time in his life started to poop all over the house.

 

[mrsgreenjeens]

I see it where it's a long term side effect. But he's only been on a few days, right? That's not long term, IMHO. But in any case, as you've already discussed it with your Vet, I guess you're good to go.

As far as Metro working on a UTI, it's more for the digestive tract. And not all antibiotics work the same. Casein point, one of mine just had some urinary issues, and the first antibiotic he was on, which typically works for what ailed him, did NOT work. So I had them run a culture to find out exactly what bacteria he had, and it turned out there are only three antibiotics that would work, two of which our Vet doesn't like to use because of one thing or another. So we kept our fingers crossed that the third would work, and after a 14 day course of it, we waited another two weeks and just took him in for another urinalysis. Came back clean. Whew! With my guy, I was shocked he had any problems in that department. I took him in because I thought he had thyroid issues, which just goes to show you never know.

Good luck with your little one. Hopefully this is a short term deal You might want to re-read some of the suggestions above about ways to feed them different foods as it is apparent the IBD cat needs very specific food that the other cat may not eat. Did anyone giveyou this link yet? Feline Nutrition – IBDKitties

 

[JC fka JClark]

I see it where it's a long term side effect. But he's only been on a few days, right? That's not long term, IMHO. But in any case, as you've already discussed it with your Vet, I guess you're good to go.

As far as Metro working on a UTI, it's more for the digestive tract. And not all antibiotics work the same. Casein point, one of mine just had some urinary issues, and the first antibiotic he was on, which typically works for what ailed him, did NOT work. So I had them run a culture to find out exactly what bacteria he had, and it turned out there are only three antibiotics that would work, two of which our Vet doesn't like to use because of one thing or another. So we kept our fingers crossed that the third would work, and after a 14 day course of it, we waited another two weeks and just took him in for another urinalysis. Came back clean. Whew! With my guy, I was shocked he had any problems in that department. I took him in because I thought he had thyroid issues, which just goes to show you never know.

Good luck with your little one. Hopefully this is a short term deal You might want to re-read some of the suggestions above about ways to feed them different foods as it is apparent the IBD cat needs very specific food that the other cat may not eat. Did anyone giveyou this link yet? Feline Nutrition – IBDKitties

Ya, I found that site 8 yrs ago when I had another IBD cat.. Ironically it's where I found Nature's Variety Instinct cat food and yet here I am 7 yrs later.

 

[JC fka JClark]

Would a 10 day course of steroid use throw off Fructosamine test? The test was done on a blood sample which was taken approx 5 days after the last dose of prednislone(?).

 

[mrsgreenjeens]

Would a 10 day course of steroid use throw off Fructosamine test? The test was done on a blood sample which was taken approx 5 days after the last dose of prednislone(?).

I would think your Vet should probably check into that question for you. Since steroids can actually bring on diabetes, my thoughts would be that they could, but I am just guessing. If you want a professional answer, check with a professional.

 

[JC fka JClark]

UPDATE:

It has been a couple of months but I figured you an update would be appreciated. The cat tested out as diabetic is NOT diabetic.

We think that the 10-day course of steroids combined with the high carbohydrate (over 30 percent DMA) prescription food caused the cat to enter a diabetic state. Steroid induced diabetes is normally considered a long-term side effect but it obviously was not the case with this animal. Basically the fructosamine test was tainted because it covered the time period on which the cat was on the steroids and higher carb food.

The cats were transitioned back to a single protein low carbohydrate but moderate phosphorous diet comprised of a mix of wet/dry. We've had glucose checks performed a couple of times since then and his levels have been normal. Both cats seem to be doing well.

 

[mrsgreenjeens]

Great updates! Thanks for letting us know.